Surgery for thyroid cancer
A lobectomy is surgery to remove the one side, or lobe, of the thyroid that contains cancer. A lobectomy is also called a partial thyroidectomy, or hemi-thyroidectomy.
Sometimes cells collected from a lump in the thyroid during a fine needle aspiration (FNA) biopsy look a lot like normal thyroid cells (they are well-differentiated). Doctors can't tell if the lump is a benign (non-cancerous) thyroid nodule or a cancerous tumour. When this happens, doctors do a lobectomy to help make a diagnosis.
A lobectomy may be used to treat low-risk papillary thyroid cancer. It can be used if the tumour is only in the thyroid, has not grown through the thyroid or spread to other parts of the body and is 4 cm or smaller.
Near-total thyroidectomy @(Model.HeadingTag)>
A near-total, or subtotal, thyroidectomy is surgery to remove most of the thyroid gland. Doctors will remove as much thyroid tissue as they can without damaging any other structures in the neck. It is used to avoid problems that can happen when all of the thyroid is removed.
Total thyroidectomy @(Model.HeadingTag)>
A total thyroidectomy is surgery to remove the entire thyroid. It is the most common type of surgery done for thyroid cancer.
A total thyroidectomy can be done for papillary or follicular (including Hurthle cell) thyroid cancer in any risk group, especially if the doctor plans to use radioactive iodine (RAI) therapy after surgery. It is also the first treatment for medullary thyroid cancers. A total thyroidectomy is rarely used to treat anaplastic thyroid cancer.
Neck dissection @(Model.HeadingTag)>
A neck dissection is surgery to remove several lymph nodes from the neck. The surgeon may also remove other tissues around the thyroid. It is often done at the same time as a thyroidectomy.
A neck dissection is usually done when:
- the doctor thinks there is cancer in the lymph nodes in the neck based on the results of an ultrasound or a CT scan
- a biopsy shows there is thyroid cancer in the lymph nodes
- the cancer has a high risk of spreading to the lymph nodes
The type of neck dissection done depends on the size of the tumour and which lymph nodes in the neck the doctors think have cancer in them. The most common type of neck dissection for thyroid cancer is a central neck dissection. This surgery removes lymph nodes from the front of the neck near the thyroid. Doctors may also do a functional neck dissection or modified radical neck dissection if they need to remove more lymph nodes from the sides of the neck.
Find out more about neck dissection.
Surgery for advanced thyroid cancer @(Model.HeadingTag)>
The following types of surgery are used to remove as much cancer as possible and relieve symptoms of advanced thyroid cancer.
En bloc resection may be done to remove the tumour, surrounding tissues, lymph nodes and structures in the neck as one piece (en bloc). This surgery may be used to treat anaplastic thyroid cancer that has spread outside of the thyroid to tissues and structures in the neck.
Surgery for metastasis may be used to remove thyroid cancer that has spread, or metastasized, to distant organs such as the lungs, brain or liver.
Palliative surgery may be done if a large tumour causes symptoms or blocks an airway or the esophagus. The surgeon will remove all of the cancer or as much of it as possible (called debulking).
Tracheostomy is a surgical procedure to create an opening (called a stoma) in the trachea (windpipe) through the neck so air can reach the lungs. It is needed when a tumour presses on or blocks the trachea and makes it difficult to breathe. Find out more about living with a tracheostomy.
Side effects of surgery @(Model.HeadingTag)>
Side effects of surgery will depend mainly on the type of surgery and your overall health. Tell your healthcare team if you have side effects that you think are from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.
Lobectomy, total thyroidectomy and neck dissection may cause these side effects:
- hoarseness or other voice changes
- numbness and tingling feelings (often in the face) and muscle spasms caused by low levels of calcium in the blood (called hypocalcemia) and damage to the
- wound infection
- swallowing problems
- breathing problems
A neck dissection may also cause weakness in the neck and shoulder.
Shereen Ezzat, MD, FRCPC, FACP
Bible KC, Kebebebew E, Brierley J, Brito JP, Cabanillas ME et al . 2021 American Thyroid Association guidelines for management of patients with anaplastic thryoid cancer . Thyroid . 2021 : 31(3): 337–386 .
American Cancer Society. Treating Thyroid Cancer . 2021: https://www.cancer.org/.
HealthLinkBC. Thyroid Cancer. 2019: https://www.healthlinkbc.ca/.
Alberta Health Services. Thyroid Cancer Treatment in Alberta. Edmonton: 2019: https://www.albertahealthservices.ca/.
Sharma PK. Medscape Reference: Thyroid Cancer. WebMD LLC; 2021: https://www.medscape.com/.
Alberta Health Services. MyHealth Alberta.ca: Thyroid Cancer. Government of Alberta; https://myhealth.alberta.ca/.
PDQ® Adult Treatment Editorial Board. Thyroid Cancer Treatment (PDQ®) – Health Professional Version. Bethesda, MD: National Cancer Institute; 2021: https://www.cancer.gov/.
American Society of Clinical Oncology (ASCO). Cancer.net: Thyroid Cancer. 2021: https://www.cancer.net/.
National Comprehensive Cancer Network. NCCN Guidelines for Patients: Thyroid Cancer. 2020.
PDQ® Adult Treatment Editorial Board. Thyroid Cancer Treatment (PDQ®) – Patient Version. Bethesda, MD: National Cancer Institute; 2021: https://www.cancer.gov/.
National Comprehensive Cancer Network . NCCN Clinical Practice Guidelines in Oncology: Thyroid Carcinoma (Version 3.2021) . 2021 .
Kotwal A, Davidge-Pitts CJ, Thompson GB. Thyroid Tumors. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer; 2019: 81:1326–1337.